MEDICARE: DR. BRIAN JOSEPH REAGAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G585750	CA
2	174400000X	Specialist	G85875	CA

General Provider Information

NPI Number	:	1639162332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN JOSEPH REAGAN M.D.

Provider Business Mailing Address
First Line	:	6221 METROPOLITAN STREET
Second Line	:	SUITE 100
City	:	CARLSBAD
State	:	CA
Zip	:	92009
Country	:	US
Telephone Number	:	760-707-5090
Fax Number	:	760-707-5097

Provider Business Practice Location Address
First Line	:	6221 METROPOLITAN STREET
Second Line	:	SUITE 100
City	:	CARLSBAD
State	:	CA
Zip	:	92009
Country	:	US
Telephone Number	:	760-707-5090
Fax Number	:	760-707-5097

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	06/18/2010

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